Face Lift

Facial Rejuvenation as a specialty is an evolving mix of art, science and committment to safe innovation. Each of the facial rejuvenation procedures we perform can compliment other procedures. Whether you choose an office treatment or a surgical procedure, we are committed to recommending the procedure or procedures that will most readily and easily achieve your partidular aesthetic goals. If you have considered a face lift, this page and the page on Mini Face Lifts should be helpful.

Face lift surgery is one of Dr. Bentkover’s surgical passions. With over 35 years doing face lifts in Worcester and Boston, Dr. Bentkover is constantly honing his skills and evaluating the latest innovations.

In this section we try to put it all in perspective. We will discuss the different types of mini lifts and explain how they differ from each other. We will also discuss the sub-SMAS full lower face lift and more extensive variations like the triplane face lift. A face lift can give you back your jawline and your neckline.

Sagging skin, wrinkles and loss of facial volume are the hallmarks of the aging face. Your chronologic age, history of extensive sun exposure, smoking and genetics all contribute to how you look today. The smooth, more rounded faces of children and young adults have more evenly distributed fatty tissues, abundant collagen and tight underlying muscles and deep connective tissues (called the SMAS – subcutaneous muscular aponeurotic system). Over time, the skin and deeper facial tissues loosen. Folds in the chin, jawline and neck become more prominent; and your midface and cheeks may tend to lose volume. Many of our patients say, “I look just like my mother.” Some also say, “My mother has better skin than I do.” You may have the some of same genetic aging factors as your mother that determine volume loss, but maybe mom did not bake in the sun as much as you did. Baby oil and iodine, anyone?

Sound depressing? There are options.

There are a number of different kinds of face lifts that can have a dramatic effect on your lower face and jawline, midface, and neck. These procedures can enhance your facial contour and profile. Only a very few years ago most face lift procedures were basically the same, but today we have many different variations of face lifts that can customize the surgery to your particular needs and your liftstye.

So, what exactly is a Face Lift?

Face lift surgery, or rhytidectomy, is designed to restore a more youthful appearance by tightening and lifting the deep tissues of your face. Rhytid means wrinkle, and –ectomy means removal; but the medical term rhytidectomy is actually somewhat of a misnomer. A face lift really does not remove wrinkles. It involves tightening and repositioning the deep facial tissues (called SMAS) and a neck muscle called the platysma, as well as the removal of some excess skin and fat (liposuction).

Removal of wrinkles may require a skin rejuvenation procedure such as a Portrait Plasma Skin Regeneration, carbon dioxide laser resurfacing, PicoSure® skin rejuvenation, a number of facial fillers, or even Botox®. These procedures, some of which can be done in the office, are described elsewhere on this website.

Our most common mini lift can restore your jaw line and tighten the muscles under your chin. As long as your neck is reasonably tight and does not have prominent “bands”, a mini lift may work for you. Mini lifts achieve more limited results but often involve less downtime or quicker healing. The “sweet spot” for a mini lift is probably 40-55.

The most common types of mini lift combines a cheek lift and a platysmaplasty. Your cheek skin and underlying tissue (celled the SMAS are lifted vertically and the platysama muscle is tightened under your chin. Unwanted fat is removed with liposuction.

Full Face Lift (Also known as a Lower Face Lift)

If the skin and the platysma muscle of your neck form large vertical bands and/or if you need extensive liposuction, you are probably not a candidate for a mini lift. You probably will need a full lower face lift.

The upper part of the full face lift is the same as in the cheek lift part of the mini lift. The SMAS (subcutaneous aponeurotic sytem) is the most important structure in both procedures. It is a strong, membrane under the skin that is actually the extension of the platysma muscle on to the face. Dr. Bentkover generally does a SMAS flap lift in both cases. In the full face lift, however, there is much more elevation of the neck skin over the platysma than in the mini lift. The neck skin is also pulled vertically.

A full lower face lift takes about three to four hours, depending on the extent of the neck surgery. A mini lift takes about three hours.

All types of face lifts can be combined with other facial rejuvenation procedures such as a blepharoplasty (eyelid lift), liposuction of the neck, laser resurfacing, Portrait PSR3 Plasma Skin Rejuvenation Plasma resurfacing, a brow or forehead lift, cheek augmentation with implants, chin augmentation, or various facial fillers or implants to specific creases and hollows. These procedures add more operating time.

As you can imagine, with the potential for such dramatic results, a full lower face lift is a very technical and exacting procedure. Hence, it often requires 10 to 14 days of recovery time away from work or strenuous activity. Mini lifts often require less time to recover.

We have provided a lot of information on this page, but it is unrealistic to think that most people can pick the type of operation they need just by reading various websites. That is where the consultation comes in. Dr. Bentkover will spend an hour with you evaluating your face and discussing your personal aesthetic goals. If need be, he will also “morph” some images of your face on the computer. You will also meet with our aesthetic nurse to get her personal perspective on facial rejuvenation and many of these procedures. In addition, you are welcome to return alone or with family members or close friends for a second consultation at no additional charge.

YOUR PROCEDURE

Before Surgery

Dr. Bentkover’s initial consultation will take about an hour. He will carefully evaluate your face and discuss with you what you might realistically expect from a face lift. His objective is to create a natural appearance that is pleasing to you, not an operated or overly “pulled” look. He may also take some digital photos of you and simulate a face lift with our imaging software.

Our staff will give you specific instructions on how to prepare for surgery, with guidelines on eating and drinking, smoking and medications. If you smoke, we will ask you to quit for at least 1 month before and after your surgery, since smoking can have an effect on how well you heal. A smoker has a higher risk of infection, swelling and actual loss (slough) of skin near the incisions! You must stop anticoagulant medicationsand herbal preparations such as aspirin, ibuprofen, vitamin E, Gingko, St. John’s Wort, garlic, or Ginseng 10 days prior to surgery. However, we will usually give you Arnica and recommend pineapple juice (for its Bromelein content) before and after surgery. These are herbal preparations that we think decrease swelling and bruising. You will be required to take antibiotics to prevent infection. You should shampoo your hair the night before surgery.

The Procedure

A face lift is frequently performed in conjunction with a blepharoplasty (eyelid surgery), forehead lift, chin augmentation, facial resurfacing, and/or liposuction to create an overall rejuvenation of the face. The procedure may need to be repeated a number of years later, since the effects of aging and gravity continue. You will be the judge of when or if you need further surgery.

Face lifts are most commonly performed in the Same Day Surgery Unit of Saint Vincent Hospital at the Worcester Medical Center. General anesthesia or local anesthesia with intravenous sedation is required. Dr. Bentkover will make an incision that starts at or inside the hairline at the temple or sideburn, continues behind the cartilage in front of your ear canal (the triages) and ends at the scalp area. Dr. Bentkover may need to alter the incision to prevent further elevation of you sideburn. The mini lift incision does not extend as far up behind the ear as with the full face lift. It is the so-called “short incision’ face lift. These incisions are placed in such a manner that they generally hide very nicely. Most women can wear their hair up in a few months without worry of unsightly incisions. Excess skin is removed and sagging muscles and connective tissues (called the SMAS) are tightened. Incisions are closed carefully and every effort is made to hide them as much as possible.

Recovery: What to Expect

You will be given explicit pre- and post-operative instructions. By following these instructions, you will minimize potential problems. It is necessary to have someone drive you home and stay with you for the first 24 hours. If you live an hour or more away, we prefer you stay overnight in one of hotels near the hospital. Initially you will have a large dressing wrapped around your head, and your neck will feel very tight. You might have surgical drains. These will be removed in approximately 24 hours. Often there are no drains. Stitches around the ears will be removed in a few days or dissolve on their own. The scalp sutures or staples will be removed in 7-10 days.

Generally scars fade satisfactorily over a number of weeks, but maximal fading may take a few months. Most swelling and discoloration generally decreases within two to three weeks, but some in some areas it may take months to subside. You are usually “presentable” in two weeks. Tightness in your face and neck will be present for several weeks, and there may be slight changes in your hair pattern around the incision. Dr. Bentkover will discuss all these details with you and show you the location of the incisions. If you have had a face lift previously, your hairline may be a bit high at the sideburn area.

We recommend that you avoid the sun after surgery. Also, remember that one of the major factors that led to you having the surgery was probably sun exposure. In order to preserve the results of your surgery and prevent unwanted thick scars, we actively discourage excessive sun exposure and encourage high SPF sun protection SPF 45-75.

Complications following face lift are very rare but can happen. They may include bleeding, infection, loss of a small amount of skin nearthe ears, facial nerve injury, discoloration of the skin, numbness that persists, asymmetry and excessive scarring. Numbness around the ears for a few months is common. Infection is rare due to the large blood supply to the face. The risk of bleeding is greater if you take aspirin or blood thinners within 10 days of the surgery. The risk of wound complications is higher in smokers, diabetics, persons with a history of radiation and autoimmune or collagen diseases.

The healing process is gradual, so you may not appreciate the final result for up to six months. A single procedure usually achieves the desired results. On occasion we may suggest we do a bit more platysma tightening in the office at six months out. It tends to settle sometimes. Most patients do not have another face lift later in life, but the number of patients having second face lifts is definitely growing. Most patients who have had face lifts are pleased with their new, more youthful appearance. They appreciate the return of a more youthful jawline and neckline.

Remember from our discussion on the previous pages that a full face lift = a cheek lift + a neck lift. Dr. Bentkover believes that it is not realistic to believe that a full face lift or a well done mini lift can be performed as effectively and as safely under straight local anesthesia as it can under local anesthesia with sedation or general anesthesia.

Face lifts done with only straight local anesthesia are generally limited procedures that usually involve just tightening sutures placed in the deep tissues (the SMAS) in front of the ear. They are usually a form of a mini lift, specifically a limited cheek lift. Dr. Bentkover does not believe that just placing tightening sutures in the SMAS is sufficient, even for a mini lift. He prefers what is called a SMAS flap, which generally requires more anesthesia for comfort and safety.